What I hear on the radio and read in the news as I work in the industry has me heartsick. Science, common sense and common decency say we cannot be a healthy or just nation when some of our hardest workers are one health problem away from bankruptcy. I see the expensive and devastating consequences of having to postpone basic preventive care. With a demographic bulge of older Americans entering Medicare, it seems insane to set them up to enter with dire needs when basic primary care could keep most of us healthy.

On the front lines of health care are millions of low-wage workers, many of whom lack health insurance themselves. They will be some of the first people who will benefit from strong health care reform. If you don’t think of a family, a worker, or an elder when you hear the word, ‘Medicaid’, you should. These are the people I serve. Why should those whose labor makes a public good possible be denied the benefits?

The federal spending issue turns on the expansion of Medicaid. Under the ACA, millions of the working poor – people with incomes up to 133 percent of the federal poverty level – are eligible for Medicaid. From 2014 to 2016, the federal government will pay 100 percent of the costs. Then its share decreases, to 90 percent after 2020. Because the ACA also gives states assistance with their new administrative costs, overall state spending will actually be lowered.

Twenty-six states are claiming that this conditional spending unconstitutionally coerces them, because they cannot realistically forgo the money, and because if they refuse to expand their rolls, they might lose every cent of Medicaid money. But let’s be clear: This is not about the states wanting to conserve their own money. It is about the states refusing to spend federal money, to help people that they do not want to help. (Paul Clement, the attorney for the challenging states, declared that his argument would not change if the federal government permanently paid 100 percent of the costs.)

Last week at Brown I heard a legal expert, Sara Rosenbaum, say that this case is the most important since Brown v. Board of Education. Those times also were contentious and painful. This time I fear that we will land on the wrong side of history.